Localized alveolar sandwich osteotomy for vertical augmentation of the anterior maxilla

Abstract

Extensive resorption of the alveolar ridge in a vertical direction may make implant insertion impossible, and aesthetic prosthetic rehabilitation is therefore compromised. Restoration of the atrophic anterior maxilla in the vertical direction can be resolved in several ways. Surgical procedures that have been proposed have used an autogenous corticocancellous onlay or inlay bone graft with primary or delayed implant placement.‘” We describe new surgical method based on a sandwich osteotomy of the basal alveolar bone, using an interpositional bone graft harvested from the chin to increase the vertical dimension. Surgical Technique A horizontal incision is made approximately 5 mm above the mucogingival reflection in the labiobuccal gingiva of the edentulous area. A flap is raised without detaching the palatal mucoperiosteum to expose the anterior wall of the atrophic maxilla. Two vertical and 1 horizontal bone cut are then made 4 mm under nasal floor (Fig 1) at the basal bone level. Using a small chisel, the osteotomy is completed and the fragment is downfractured, pedicled to the palatal mucoperiosteum (Fig 2). The caudal fragment must not be less than 5 mm thick. A partial-thickness bone graft is harvested from the mandibular symphysis and placed as an interpositional graft, without fixation, between the residual basal bone and the caudal fragment with the cortex facing superiorly (Fig 3). The bone graft must not be more